1. Is there a difference between physical activity and exercise?

2. What are the benefits of physical activity and exercise?

3. How do I prepare for physical activity?

4. How do I get motivated?

5. How much can I do?

6. When can I do physical activity or exercise?

7. What are the different types of exercise?

8. How do I work exercise into daily life?

9. Are there any tips for exercising with my type of arthritis?

10. Final points to remember

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1. Is there a difference between physical activity and exercise?

 

Physical activity refers to activities that are a part of your everyday life. They include household, workplace and lifestyle activities that can be taken advantage of to help you become more active (click here for more information on how to work physical activity into your life). Exercise is a type of physical activity that uses exertion to improve at least one aspect of your physical fitness. Many of the sample exercises listed in this booklet are exercises with specific benefits for people with arthritis. It is also important to consider whether your regular diet is balanced, giving you all the important basic nutrients. If it is not, then your general health will suffer and this may have an effect on your arthritis.

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2. What are the benefits of physical activity and exercise?

 

Exercise can help you improve your health and fitness without hurting your joints. Did you know you’re ‘feeding’ your joints when you’re active? Cartilage depends on joint movement to absorb nutrients and remove waste. Maintaining a healthy body weight is another important part of arthritis management. Did you know that losing 1kg of excess weight decreases stress on your knees by 4kg? By increasing physical activity, you can make a difference to your joints and overall health. Along with your current treatment programme, regular, moderate exercise offers a whole host of benefits including:

  • Reduces your joint pain and stiffness
  • Strengthens the muscles, ligaments and cartilage around your joints
  • Helps you maintain bone strength and quality
  • Increases your joint range of motion and joint mobility
  • Improves your balance
  • Gives you more strength and energy to get through the day
  • Helps you control your weight
  • Makes it easier to get a good night’s sleep
  • Makes you feel better about yourself and improves your sense of well-being
  • Improves your ability to manage stress
  • Reduces the risk of other chronic conditions
  • Promotes stronger heart and lungs
  • Lowers your blood pressure and cholesterol

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3. How do I prepare for physical activity?

 

My healthcare team

Before you start to exercise it is important to talk to your healthcare team. Although many people with mild to moderate arthritis are aware of what type of activity best suits them, it is still no harm to speak to your doctor as they may provide you with some additional insight. For people with more severe symptoms, professional medical advice is even more important. You might get a referral to a physiotherapist or personal trainer who has experience working with people with arthritis and can help you find the exercise plan best tailored to give you the most benefit with the least aggravation of your joint pain.

Planning

One of the most challenging and important elements of a successful exercise regime is maintaining a regular cycle all year-round. This can be especially difficult when you are experiencing pain, stiffness or fatigue. But these symptoms are the very reasons to make exercise a habit! Scientific evidence shows that people with arthritis who exercise regularly get significant symptom relief, giving them a far greater quality of life.

Maintaining your exercise regime does take a strong commitment but by coming up with a plan you can give yourself every chance of making exercise a success!

For example, depending on your interests you can do a half hour session of aerobic activity, such as walking, every weekday evening and a 30 minute session of muscle strengthening in the gym on a Wednesday and a Saturday.

When it comes to living the best you can with arthritis, you need to determine what strategies and tactics make sense and are appropriate for you.

Creating my plan

  • Make exercise a priority: Plan and prepare in advance so your time for exercise is not compromised. Adopt the mindset that other things can wait! Exercise is your priority. Remember, you can get active in many ways, so look for
  • opportunities whenever and wherever you can find them. Set goals: Set yourself up for success by making goals that are achievable taking into account your current fitness level and your interests and lifestyle. It’s a good idea to have a big goal, but wise too to set small, realistic goals that will work like stepping stones, helping you reach the bigger objective. Click here for more advice on goal-setting
  • Anticipate obstacles. Pain, fatigue, illness, work or other obligations, and even the weather can mess up your plans. Have a plan B in place, and know when rest is the better plan.
  • Do what you enjoy. Your chances of sticking with an activity will be far greater if it is something you like, that feels good or excites you, or that makes you feel happy while you’re doing it. Also, if you keep it simple you’re more likely to keep at it.

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4. How do I get motivated?

 

Increasing your level of physical activity or starting an exercise programme can be difficult and you may face many physical challenges such as pain and fatigue. However sometimes the biggest challenge is getting your mind exercise-ready and without motivation and goals you won’t get very far. In this section we are focusing on the psychological factors that prevent us moving more and provide tips to help you achieve your personal exercise goals, while also helping with your overall psychological well-being.

 

1. Overcoming the barriers

It is human nature to come up with reasons not to exercise when you don’t feel like being active. Here are some of the more common excuses people use, as well as some advice on overcoming them. Try to identify the excuses that you like to use and have a ready-made response.

“I am too busy”

No matter how tight your schedule is, there is always room for exercise. When planning your programme, take into consideration time needed for work, hobbies or family, and decide which parts of the day you can set aside for physical activity. Try to include the 30 minutes of activity as part of your daily routine, e.g. walking to shops at lunch time. Remember you can do 15 minutes of activity twice per day or 10 minutes three times a day.

“I am too tired”

For many of us when we are tired, taking exercise ranks low on the list of desirable activities. Although it may seem counterintuitive, exercise actually helps to reduce tiredness and fatigue and boost energy levels. If your activities leave you feeling overly tired, you’re probably doing too much too fast.

“I am self-conscious”

Exercising in front of other people can seem daunting sometimes, especially if you do not feel confident in your exercise ability. Everyone has a different level of fitness and most people who exercise do not have the perfect body. Wearing loose clothing when exercising with others can help if you are worried about how you look and exercising in water can hide limitations if you are worried about keeping up with a class.

“I’m in too much pain”

It’s important to remember that, in the long term, physical activity will decrease the pain caused by your arthritis. Try exercising while sitting, lying down or in water. Applying heat or cold treatments where appropriate can neutralize the pain and if the pain does not subside, take a break. You can return to your regime when you feel better.

“I don’t like physical activity”

There is a type of physical activity to suit everyone, try out a few new activities to help you find one that you enjoy. It doesn’t have to be traditional sports, it could be dancing, gardening, or skipping. Ask your friends what activities they enjoy and maybe you could join them.

“The weather is bad”

Dress appropriately to suit the weather conditions. You can be as physically active indoors as outdoors. If you find outside conditions too hot or cold, try walking on a treadmill or muscle strengthening in the gym, or swimming at a community pool.

“I’m afraid of falling or losing my balance”

If a fear of falling is holding you back, start by doing activities on a chair, in your bed or leaning against a wall. You will notice that, as you progress, you will increase your strength, your balance will improve and you can gradually increase the number of activities you complete standing without support.

 

2. Making a commitment

The first thing to do is to ask yourself: Why are you being active? Do you want to control your arthritis symptoms, lose weight, sleep better, increase your energy, gain strength, add muscle tone and flexibility, or just feel a heightened sense of well being? Each individual is motivated to become active by something unique to them and so it is important to find the thing that is most important to you and not to anyone else. If you focus on the benefits that you can get from exercise then you have a better chance of staying active. Make a contract with yourself and hang it somewhere you can see it to remind you of your reasons for being active and your commitment to achieving your goals.

 

3. Being prepared

Have the right gear. This can make all the difference in the comfort level of your workout and as a result it will make the workout more enjoyable for you. A good pair of shoes is essential. And weather resistant clothing or a membership to an indoor gym can help you fight off your own excuses when weather conditions are less than ideal.

 

 4. Goal setting & rewards

  • Set goals for yourself:

Set one main goal for yourself to achieve. Personal achievement will increase the enjoyment for you. This goal needs to be realistic such as being able to walk for 20 minutes or to cycle for 20 minutes without stopping. You will be amazed at how quickly your level of fitness improves and how quickly you can achieve these goals. Remember to progress slowly onto the next goal.

  • Don’t set goals too high:

they should be realistic and short term. Choose one exercise that gets done rather than having a long programme in the drawer that only gives you a bad conscience.

  • Keep a diary or a log of your activity

Use your diary to schedule your daily exercise. At the beginning of each week, plan out your activity for the week. If you look at the diary at the end of the week, it will help you identify reasons for not sticking to your proposed plan and could help you to stay motivated.

  • Set rewards for yourself

Once you achieved a goal that you set for yourself it is important to reward yourself for achieving that goal. For example, tickets to a show, the cinema or to a match, buy yourself new clothes etc.

  • Chart your progress

Chart the number of weekly minutes you achieved over a number of weeks. Hopefully you will see how easily you increased your activity levels. A pedometer or step counter is a useful device to help you track your activity levels.

  • Vary your routine once you reach your goals

Change your routine as you reach new goals. If you increase the intensity or the duration of your workout, or by trying a new workout or sport, this will provide new momentum for you.

  • Cope positively with lapses

We all have bad days when we don’t manage to get out doing our activity for one reason or another. Having arthritis may mean that you sometimes have to take an unscheduled rest day. If you miss a session, don’t worry, but don’t let the regime slide by getting out of the exercise habit.

  • Finally...

Don’t stop exercising once improvements begin to show. To maintain the benefits, exercising has to be a life-long commitment.

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5. How much can I do?

 

Be as active as your ability allows and set goals to help you achieve the adult guidelines (30 minutes of moderate intensity activity 5 days of the week). You can do 30 minutes continuously or combine several 10 to 15 minute sessions. If you have not exercised for a while, you may need to start with shorter sessions and build up slowly. Talk to your doctor or a physiotherapist about getting started to help you avoid an injury through over-doing it. Don’t forget that activities such as gardening, playing with pets or taking the stairs rather than the lift can also count as exercise. Whether your activity is moderate or vigorous, the goal is to keep moving.

Examples of moderate activity include:

  • Brisk walking; a kilometre in 12-15 minutes
  • Medium paced swimming
  • Water aerobics
  • Cycling slower than 15km per hour
  • Ballroom dancing
  • General gardening

Knowing your limits

It can be hard to predict how your body will cope with a new activity. During the first couple of weeks of a new routine, you can expect to feel some increase in discomfort because muscles are probably being worked in a way they are unaccustomed to. However, if an exercise hurts, especially in the joint itself stop doing it and check with a GP or physiotherapist before you try that particular exercise again. Generally, if you have finished exercising and an hour later you are still aching or feeling more than when you started, you may have overdone it a bit.

Other signs of overdoing it are persistent fatigue, decreased range of movement, increased joint swelling and continuing pain. If you experience any of these symptoms, seek immediate advice from a doctor or physiotherapist. Don’t be put off. Next time, slow down, do less and build the routine up gradually.

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6. When can I do physical activity or exercise?

 

It doesn’t matter when you exercise, as long as you do so regularly. If possible, try to exercise when your pain, fatigue and stiffness levels are at their lowest and when your medicines are at their most effective. Remember that painkillers can mask pain, so be careful not to push too far until you know what your limits are.

Remember that painkillers can mask pain, so be careful not to push too far until you know what your limits are.

Exercising during a flare-up

Some people with certain forms of arthritis, such as rheumatoid arthritis or ankylosing spondylitis, experience what is known as a flare-up – a time when inflammation is suddenly more active and pain, swelling and stiffness get worse. Flare-ups can last from a couple of days up to a few weeks.

It is important to keep doing gentle exercises during a flare-up, especially range of movement exercises. Doing this daily within your pain-free range may even decrease and shorten the flare-up, however, cut down on the rest of the routine and cut out the more strenuous exercises. If only one joint is affected by the flare, try adapting the exercises to give the rest of the body a good workout while not aggravating the affected joint. You can also do an activity with a lower impact, for example swimming or stationary cycling can be substituted for walking when you have hip, knee or ankle pain. As the flare-up improves, slowly build up the routine again. Don’t pick up at the same level as before as some physical fitness may have been lost, especially if the flare lasted for some time.

Exercising with a joint replacement

For some people with arthritis, joints such as hips, knees or shoulders become so damaged and painful that replacement surgery is necessary. If this happens there are a number of steps that can be taken in the lead up to the operation.

  • Don’t wait for the operation, do exercises beforehand to strengthen the muscles around the joint that is being replaced. This speeds up recovery after the operation.
  • It is best to do non-weight bearing exercises such as swimming and cycling.
  • Do range of movement exercises – range of movement can be hard to regain after an operation.
  • Exercise should not be excessive.

After the operation you can expect to work with physiotherapists to get the new joint moving. It is very beneficial to keep exercising gently and to gradually build up the exercise you do as you get stronger. You may be worried that you will damage the operated joint but remember that sensible exercise will help strengthen the muscles around the joint.

Some things to remember when exercising after your joint replacement:

  • Check with your surgeon or physiotherapist before beginning a routine and ensure the correct technique is being used when exercising.
  • As you build strength you can start taking part in a range of low impact activities, like walking, cycling or swimming.
  • If you have had a hip replacement, the most common time to dislocate your hip is up to six or eight weeks after your operation, so take great care during this time.

Being physically active through pain

Pain is one of the hallmark symptoms of arthritis. It may come and go as your arthritis flares or subsides, but for many people, pain will never entirely disappear.

If you experience pain for two hours after you exercise, you may want to work with a physiotherapist, who can help you distinguish the difference between muscle pain and joint pain. Muscle pain (within limits) is normal, just like when you do something you have not done for a while. Joint pain is not normal and is not something you should be experiencing. If you do experience joint pain or unusual pain after an activity, it is important that you stop and seek advice from a physiotherapist who will modify and monitor your routine.

You may be reluctant to exercise because you are in such pain. If this is the case you may want to start with a water-based exercise programme. In the water, your body’s buoyancy reduces stress on your joints while building strength and increasing range of motion. There are many aquatic programmes and exercises that are great for people with arthritis, like hydrotherapy or aqua aerobics. A hot or cold pack can also help relieve pain in specific areas before or after exercising.

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7. What are the different types of exercise?

 

Exercise will not make your arthritis worse – as long as it is the right sort. There isn’t just one particular exercise or activity that is recommended for all people with arthritis. Choose an activity that you enjoy and that is convenient for you to do. Low-impact exercises, with less weight or force going through your joints, are usually most suitable.

Examples of low-impact activities include:

  • Walking
  • Swimming and exercising in water, such as hydrotherapy (with a physiotherapist)
  • Cycling
  • Yoga, Tai Chi and Pilates
  • Dancing

The wrong sort of exercise could put strain on your joints and damage them further. Ask your GP to refer you to a physiotherapist, who will help you work out an appropriate programme depending on the type and severity of your arthritis and your general level of fitness. There are three main types of exercise for people with arthritis:

  1. Range of movement
  2. Strengthening
  3. Aerobic exercise

A good exercise programme will generally include a combination of all three.

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1. Range of movement

Range of movement (ROM) exercises form the backbone of every exercise programme. It is important to do these as they help maintain flexibility, relieve stiffness and are important for good posture and strength. Range-of-movement exercises involve moving your joints through their normal range of movement and then easing them a little further, such as raising your arms over your head or rolling your shoulders forward and backward. ROM exercises are done smoothly and gently so they can be carried out even when in pain and during a flare-up.

Tips for range of movement activities

  • ROM activities are best done daily in a non-weightbearing position, such as lying or sitting on your bed or couch.
  • When doing ROM exercises, move your joints within the full range as much as you can tolerate and not any further.
  • If you are experiencing pain in your joints, your ROM will be limited, but it is important to move within your limits every day.
  • For ROM exercises, if the joint you are moving feels good you can repeat these activities five to 10 times, holding each position for no more than three seconds.
  • Stretches are best done when the muscles are warm, such as after a walk or fitness class.
  • Stretches should be a smooth movement; avoid bouncing or jerking.
  • If the joint you are moving is hot, swollen or painful, avoid stretches for that day.

 

2. Strengthening

Strengthening exercises are important for everyone, but especially for people with arthritis, because they help strengthen the muscles which move, protect and support your joints. Many people become less active when they develop arthritis because of the pain and fear of causing damage. This can lead to muscle wastage and weaker joints. By developing strong muscles, joints become more stable and activities such as walking and climbing stairs are easier.

Strengthening exercises encourage the body to work harder than normal. Start slowly, gradually building up the repetitions. As the muscles get used to doing more, they become stronger. The type of exercises you do will depend on which joints are affected and how severe your condition is. Always check with a doctor or physiotherapist before starting a regime.

Strengthening exercises are done by tightening and releasing the muscles around a joint. The type of exercises you do depends on which type of arthritis you have, which joints are affected and the severity of your condition. Some exercises may be harmful so always check with a doctor or physiotherapist before starting on a regime –they may be able to suggest alternative moves.

There are many ways you can do muscle strengthening activities:

  • Lifting weights using machines, dumbbells, or weight cuffs
  • Working with resistance bands
  • Using your own bodyweight as resistance (e.g., push-ups, sit ups)
  • Heavy gardening (e.g., digging, shovelling)
  • Some group exercise classes.

Tips for strengthening activities

  • It is important to avoid doing strengthening exercises on consecutive days so that you have a day of rest in between.
  • When starting out, it is advisable to use light weights or resistance bands.
  • Pick a resistance that allows you to do 10 to 15 repetitions. As your strength improves and this becomes easy, you can progress to heavier weights or stronger resistance bands and continue to progress to a weight or resistance level you can tolerate.
  • If the joint you are moving is healthy or free of pain, you can repeat the strength exercises 10 times. If the joint continues to be pain-free, then you can increase the number of repetitions to three sets of 10.
  • Always take a break after each set and in between activities.
  • If the joint you are exercising is slightly swollen and only mildly painful, cut the repetitions in half and increase their number only very gradually.
  • If the joint you are exercising is hot, swollen and painful, do not perform strengthening exercises without first consulting your health-care provider.

 

3. Aerobic

Aerobic just means exercise that raises your heart rate and makes you breathe a little harder than when you are stationary. This form helps with your overall fitness and is also known as endurance or cardiovascular exercise. It uses the body’s large groups of muscles in continuous motion.

Aerobic exercise burns off calories, speeds up the body’s metabolism, helps maintain a strong heart and helps muscles work more effectively. It also helps control and reduce weight, improves sleep, strengthens bones, reduces depression and builds up stamina. Begin any exercise by stretching to warm up. To get any benefit, aerobic exercise must be done for a prolonged period (20-30 minutes) two to three times a week. These exercises done correctly and consistently will provide some relief from the pain of arthritis, help with good posture, and increase your energy and vitality.

Forms of aerobic activities

There are so many aerobic activities, so it is advisable to find at least one that is both enjoyable and appropriate for your joints. The best forms of low-impact aerobic exercise for people with arthritis are walking, cycling and swimming. These are all discussed below in more detail.

Other popular aerobic activities include golf without a buggy, gardening, vacuuming and low-impact dancing.

  • Walking

For people with arthritis, walking puts less stress on your joints and is considered to be much better and safer than running. Walking allows you to stretch your back, leg muscles and joints that can become stiff from sitting. Walking is also relatively inexpensive; all you need is a good pair of walking shoes that have flexible soles and provide adequate arch support. Another benefit of walking is that it can be done at almost any time in any place. If you have hip, knee, ankle or foot problems, it is important to confirm with your healthcare provider that this is an appropriate activity for you.

  • Swimming & water activities

Water activities are helpful because your bodyweight is supported, and moving through the water adds resistance. This boosts muscle strength and endurance. Activities such as stretching or walking through water can exercise the joints without putting them under strain. The soothing warmth and buoyancy of warm water make it an ideal environment for relieving arthritis pain and stiffness.

You don’t have to be a good swimmer to exercise in water! You can use the shallow end of the pool, hold on to the side or use a flotation device. Since exercising in water is relatively easy, you may be tempted to overdo it. If you’re in an aquafit class, start off slowly and don’t try to compete with the more experienced participants or keep up with the music.

  • Hydrotherapy

Gentle exercise can be carried out in hydrotherapy pools that will usually be heated to around 34 degrees centigrade. The warm water soothes the joints, relieves stiffness, and promotes better blood circulation. It is ideal for gentle, low-impact exercise and also offers the resistance needed to keep muscles and joints in shape.

Because the water supports your weight, the range of movement in your joints should increase and

pain should decrease. Most hydrotherapy pools range in depth and if you cannot lower yourself into the water, there will usually be a hoist.

  • Cycling

Cycling, whether done outdoors or on a stationary bicycle, strengthens muscles and is also a good cardiovascular workout for your heart and lungs. Just remember that the seat height should be adjusted so that your knee is slightly bent when the pedal is at its lowest point. For those with a sore back, the seat and handlebars can be adjusted to ensure your back is not too stretched out. If you are using a stationary bicycle, a recumbent model can decrease back strain, as you will be sitting up while cycling. Cycling is an ideal endurance activity because it provides much-needed resistance, however, if you have knee problems, it is advisable to start slowly and use the least amount of resistance when cycling. A lower resistance can be achieved by ensuring your gears are at the lowest setting.

Tips for aerobic activities

  • When you start out, strive for a moderate intensity level with slight breathlessness and an increased pulse but you can still talk comfortably and feel warm with some sweating.
  • Check with a doctor before beginning a regime, especially if you have moderate to severe arthritis, a heart condition or high blood pressure. Avoid activities that include jumping, rapid twisting, turning and sudden stops, as they are very stressful on your knees and spine.
  • Before starting to exercise, warm up by doing some gentle stretches. Likewise, cool down after stopping. This can be done by slowly doing a bit more of the exercise you were doing or by doing more stretching exercises.
  • It is recommended that aerobic exercises are done for a prolonged period (20-30minutes) two to three times a week. If this is too much to begin with, build up slowly until the body is ready for a full workout. If you find it too much to do 20 to 30 minutes at one time, try doing blocks of 5 to 10 minutes, resting in between, until you have done a full workout.

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8. How do I work exercise into daily life?

 

If you are not physically active or have never exercised before, starting a new routine might seem intimidating. Although it is important to maintain regular, structured exercise, it is possible to incorporate exercise into a daily routine in surprisingly easy ways. Physical activity cannot replace structured exercise, but it does help maintain joint movement and fitness. Try incorporating one or more of the following into your daily routine.

  • Vacuuming is a good example of aerobic exercise. It uses both arm and leg muscles, particularly if using an upright cleaner. Washing floors gives a similar workout. Don’t try to do the whole house at once, build up to a maximum of 20 to 30 minutes to get a good aerobic workout.
  • Doing the washing up can also help maintain movement. Washing up in warm water can help loosen up finger joints and emptying the dishwasher can help stretch arm and leg muscles
  • Learn to play the piano or take up knitting: Both of these hobbies are great exercise for fingers and can be very enjoyable. Playing the piano in particular gives fingers a good stretch.
  • Gardening is another good opportunity to exercise joints. Making a few adaptations to the way you garden may be necessary (perhaps using different equipment), but gentle gardening activities such as digging, pruning, raking and weeding allow for stretching without putting too much stress on joints. Changing gardening jobs regularly works different sets of muscles. Try doing a little, often. Limit it to a maximum of 30 minutes at a time to avoid overdoing things.
  • Use the stairs instead of taking lifts and escalators if you do not have problems with your hips or knees.
  • Make more than one trip from the car to the house with the groceries.
  • Walk to the local shop instead of driving.
  • Get off one stop early if you take public transport.

Exercise at work:

  • Take frequent ‘stretch’ breaks at work to walk to the water cooler or bathroom.
  • Choose a parking spot furthest away from the entrance.
  • Walk down the hall instead of using the phone or e-mail.
  • Take a walk during the morning or lunch break.
  • Walk /cycle to work
  • Go to the gym /swim during lunch.

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9. Are there any tips for exercising with my type of arthritis? 

People living with certain types of arthritis may find that their symptoms dictate how and when they exercise. The following information is intended to give some tips to help people living with osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and fibromyalgia.

If you have a condition not mentioned here and would like information about appropriate exercise, talk to your doctor or physiotherapist, or call the Arthritis Ireland Helpline on 1890 252 846.

Osteoarthritis

  • Regular exercise is one of the best ways of relieving the symptoms of osteoarthritis. Keeping active strengthens the muscles around the joints helping to prevent further degeneration. Exercise can help to maintain a healthy weight, which will reduce the strain on certain joints.
  • Develop a moderate exercise programme – a strenuous programme may cause more pain and possibly accelerate deterioration. It is advisable to do range of movement exercises every day on every joint.
  • The regime should not increase your levels of pain beyond the two-hour rule.
  • Never force a painful joint.

Rheumatoid arthritis

A successful exercise regime requires a balance of rest and activity for people with rheumatoid arthritis.

  • Exercise when levels of pain, fatigue and stiffness are at their least.
  • Do range of movement exercises at least once a day. If done in the morning, they help ease morning stiffness.
  • Strengthening exercises are important to build muscle to protect and support joints.
  • Low impact aerobic exercises such as swimming and cycling are good for people with rheumatoid arthritis.
  • Always maintain good posture.

Fibromyalgia

  • Exercise is also beneficial for people with fibromyalgia, increasing fitness levels, improving sleep and helping them cope with pain better.
  • Vigorous exercise makes some people with fibromyalgia worse – low to moderate aerobic and strengthening exercises are best for people with the condition.
  • Incorporate range of movement and gentle strengthening exercises into daily routine.
  • Maintain good posture.

Ankylosing spondylitis

  • Appropriate exercise is vital for managing ankylosing spondylitis.
  • Stretching exercises of the neck, spine, shoulders and hips are particularly important.
  • Strengthening exercises for the back and hips are good for helping to maintain good posture.
  • Swimming is an excellent exercise for people with ankylosing spondylitis. If you have neck restrictions, try using a mask and a snorkel to breathe while swimming.
  • Avoid jerky movements and high impact exercises.

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10. Final points to remember

Safe, enjoyable physical activity is possible for most adults with arthritis. Now that you have learnt more about the benefits of safe and appropriate exercise to help you manage your arthritis better, here are some important points to remember to keep you motivated and active.

Preparing

  • Talk to your doctor before starting an exercise programme. A physiotherapist can suggest a safe exercise plan to suit your ability and goals and will make sure you are doing your exercises correctly to prevent an injury.
  • A warm bath or shower before prolonged exercise may help relax muscles.
  • Look for safe places to be physically active. For example, if you walk in your neighborhood or a local park make sure the paths are level and free of obstructions, are well-lit, and are separated from heavy traffic.
  • If you are currently inactive or do not have confidence in planning your own physical activity, a class or group designed just for people with arthritis may be a good option for you.
  • Plan your day so that you can be active without being exhausted.
  • Make sure you have supportive and comfortable footwear and wear comfortable, loose fitting clothing that is weather/activity appropriate.
  • If you have had joint surgery, check with your doctor whether there are any movements you should avoid. Also check with your doctor if you have a condition affecting your heart or lungs.

Getting motivated

  • Enjoy it! Pick a variety of activities that you enjoy, this will help keep you from getting bored and make it easier to stick with your activity plan.
  • Keep it social! Sharing the experience can be enjoyable and help keep you motivated.
  • Before you commit to any one activity, consider the settings in which you feel most comfortable (indoor or outdoor, winter or summer, alone or in a group) or attend a class first before you sign up.
  • If you’re just starting to exercise you may prefer to start with an activity programme or class designed just for people with arthritis and get support from and gain confidence by participating with other people with arthritis.
  • Set goals that are S.M.A.R.T.: Specific, Measureable, Attainable, Realistic and Time-bound!
  • Keep track of your progress by maintaining a journal, noting what you did and how you felt. Don’t be deterred if the benefits are not immediate.
  • Reward yourself- Once you have become active and reached some of your goals, it’s important to reward yourself. A good reward can help motivate you when you hit a barrier and help you enjoy your physical activities even more.
  • Keep going, it’s human to have bouts of inactivity, but remember that you can start over any time.
  • If you prefer to exercise alone give yourself something fun to do while you exercise. Find some good heart pumping music or listen to books on tape. Enter a physical activity event, such as a 5km walk or jog with friends. Many are linked with charities and the good cause will give extra motivation.

Moving

  • Aim to be active for at least 30 minutes of moderate intensity activity 5 days of the week.
  • Always start your exercise with some gentle movements and stretches to warm up your body and your joints. This can help prevent pain and injury during exercise.
  • Cool down at the end of your session with some gentle movements and stretches. This can help prevent muscle pain and stiffness the next day.
  • To start activity safely for the first time, go slow. Do less than you think you will be able to manage. If you cope well, do a little bit more next time and keep building up gradually. It’s very important that you avoid doing too much too.
  • Little and often within a daily routine is best for range of movement and strengthening exercises. The routine can be done in blocks of 5 to 10 minutes instead of all in one go.
  • Pace yourself: it’s natural to feel your heart beat a little faster, your breathing speed up a little and your body get warmer, but make sure you can speak normally while you’re being active.
  • Be alert for warning signs, such as sharp pain or more pain than usual, since pain often means something is wrong.
  • Never force a joint.
  • Activities should be easy on the joints like walking, bicycling, water aerobics, or dancing. These activities have a low risk of injury and do not twist or stress the joints too much.
  • Give yourself rest breaks during the day to compensate for the increased activity. Balancing your activities, exercise and rest times is critical to staying healthy and physically active.
  • It is best to do lying down exercises on a hard surface like the floor – your posture will be out of alignment on a soft surface. An exercise mat may make this more comfortable.
  • Apply heat treatments if your joints are not swollen or hot, to help your stiffness before you exercise. Heat helps because it increases the circulation and examples include simple things like a warm shower, a towel warmed in a microwave or a hot water bottle.
  • Cold treatments can be beneficial, especially after exercise. You may find it is easier to apply cold than heat because there is a numbing sensation which temporarily helps the pain and can counteract mild swelling. Examples include simple things like placing a bag of frozen peas over the joint for 10 minutes.
  • Drink enough fluids both before and after exercising to avoid dehydration. These fluids should supplement the eight eight-ounce glasses of water every day that experts recommend.
  • Be safe! Be Seen! Wear high visibility accessories such as arm bands and bibs if you are out and about in the dark.

Managing Pain

  • If you haven’t exercised or been very active in a while, you may experience some muscle stiffness, joint tenderness, pain and fatigue.
  • It is best to exercise when you have the least pain and stiffness, the least fatigue and your medication is having maximum effect.
  • Plan your exercise periods and active times to coincide with times when your normal, daily regimen of arthritis medications are most effective at reducing pain.
  • Most people take a while to learn how much they can and cannot do so be careful not to push too far until you know what your limits are. If you overdo it, have a rest for that day and start again the next but halve the amount you were doing. Then, gradually increase it by a few minutes each day.
  • Do not continue with an exercise that causes severe pain or discomfort.
  • If you feel more pain two hours after exercising than you did before you started, you may have overdone it. You may find that working with a physiotherapist will help you to modify the activity and pace your increase in activity level. If you are worried about starting a new exercise, then your doctor can give you a check up to make sure you would benefit from more activity.
  • It is not advisable to exercise a hot, inflamed joint. It is often too painful to move through its full range of movement, but you should move it within the limits of pain. Return gradually to exercise once the inflammation has subsided.
  • When your arthritis symptoms increase, try to modify your activity to stay as active as possible without making your symptoms worse. Decrease the frequency and the duration of an activity and you can also change the type of activity.

And Finally…

  • Remember little things do make a big difference. Even a small increase in your physical activity can make a big difference to how you live with arthritis

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